Broken Egg

Book Title: Broken Egg

Author: Raymond Downing

Publication Information: Nairobi, Kenya, Manqa Books, 2018, 242 pp., $9.69 paperback

Informative, yet subtly raising intrigue, this is the latest book by Raymond Downing, MD, an American family physician who devoted a majority of his career to providing health care in sub-Saharan Africa. Dr Downing dedicated almost his entire professional life to medical missions and rural hospitals in Tanzania and Kenya. He also designed the first family medicine training program in Kenya. A prolific writer, he authored several essays and books on global health and medicine. A pioneer of global health, his stories are influenced by his personal experiences, and thus offer a first-hand account of medical practice by an expatriate in Africa.

Downing’s choice of a captivating title, “Broken Egg” symbolizes a fragile state. A story of two doctors in Kenya, it highlights the challenges, the diseases, the bottlenecks, and the unrealized potential for effective global health care delivery in underserved countries.

Narrated in a flashback manner, the story meanders through the infrastructure, needs, politics, and philosophy of the health care system in the horn of Africa during the turbulent phase of postelection violence in Kenya from 2008 through 2011. The story unfolds in a narrative style and gradually introduces the setting, the plot, and the characters, before reaching a climax and conclusion.

Downing has drawn abundantly on his personal experiences, and has delivered a physician’s insight to the global health care, while skillfully guiding the reader through geographic, sociopolitical, and cultural nuances. The chapter “The Doctors” provides a quick view into the daily working conditions and hardships of serving in underserved areas with constrained resources. Lack of funds relentlessly push the health care delivery system against the wall. Various anecdotes throughout the book highlight the challenges for a physician that range from managing a spectrum of acute and chronic conditions, and at the same time being proficient in locally endemic diseases like sickle cell anemia, tuberculosis, malaria, AIDS, etc. Among many Kenyan communities, access to inpatient health care services is seriously constrained. The scarce resources, whenever available, are tied up to disparity in schemas of individuals and institutions.

“The Doctors Respond” goes on to describe the personal beliefs, passion, dedication, struggles, and sorrows of health care workers devoted to providing health care in resource-poor regions, and what drives them. Driven by the zeal to serve others and a mandate for global health, the medical workers may often have to conquer personal tribulations, both physical and emotional. Whereas early adopters are likely to face scarcity of resources, misplaced resource allocation, misjudged priorities and government regulations with frustration, the experienced physicians can contribute a lot to the local systems. Eventual empowerment of the local medical system happens by virtue of efficient and effective health care delivery, upgrading local expertise; or even developing a family medicine training program at the local institute, as happens in this story. Dr Downing gently and covertly attempt to connect dots of resource allocation to various global health initiatives/local governments, and their desire to be a part of the narrative through the purse-strings. Downing has masterfully handled this delicate topic with a neutral opinion, without demonizing or validating anyone. Nonetheless, he emphasizes the need for a coordinated approach by global health actors. Narrating a personal experience of one of the characters, Downing has made an emphatic appeal for policy and process improvements in this part of Africa, to address the challenges of pharmacovigilance and drug delivery issues in the interest of patient safety.

This is Dr Downing’s most recent novel, and he has succeeded to deliver the global health narrative with his usual panache and elegance. He has subtly emphasized better resource utilization, governance, priorities harmonization, and alignment for an effective coordination. A synergistic approach between the government and the development partners/donors to the often-fragmented health care services is needed for realistic global health initiatives and interventions. His personal narrative makes this need human, emotive, and engaging. This book is a must-read for health care providers who are passionate to advance global health.